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Dying with dignity

Hollis Johnson, left, and his wife Lee Carter leave the B.C. Court of Appeal Thursday after the court ruled on assisted suicide. (DARRYL DYCK / THE CANADIAN PRESS)

Sat., Oct. 12, 2013

Re: Death to death with dignity, Oct. 7

Death to death with dignity, Oct. 7

Rosie DiManno’s idealism regarding assisted suicide might to commendable and she is entitled to her opinion, as are we all.

However, despite her strong feelings against this, discussing the concept remains long past due. The fact is that more and more people are speaking out in favour of assisted suicide (or death with dignity) and would like to have that option whether they ever choose to use it or not.

It would seem therefore that there should be some public discussion on the subject and a referendum or some other means of determining what percentage of people in Ontario want this choice.

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DiManno’s belief that terminally ill people should have to remain alive until they die naturally even if they are suffering terrible pain or consider that the quality of their life is such that they no longer want to be alive. Obviously, all of us have that option and legalizing assisted suicide would not change that.

But for those who wish to exit life should it become unbearable for them the option of ending it should exist.

Frances Weingarten, Toronto

Rosie DiManno has entered into the debate around assisted suicide. She does not approve of such; in fact she states that we must delight in the spiritual and existential dimension the dying gives us. No matter how much the dying is suffering, we must enjoy this gift. No doctor with a God-complex should be allowed to make treatment suggestion. She also mentions her dying pets, this is where it gets grotesque and cheap.

Dr. Low brought this issue to life in a very compelling way, suddenly it had a face and what a face. One of our most respected citizens in our living room at prime time with the most personal story a human can bring — his wish to die with dignity. He passed away shortly after without getting his wish fulfilled but he certainly put it on the agenda.

All our lives we make decisions, but when it comes to the ultimate one we are not allowed? What gives DiManno or any other person the right to dictate how many of us will face death.

I have for the last several years unfortunately spent more time thinking about my own mortality and my own passing. I know that down the road, a year, two, maybe five I will most likely find myself in Dr. Low’s position.

I know my disorder will bring excruciating pain, broken bones, spinal compression, catabolic disaster and finally death. I know there is no cure and the outcome is obvious but I don’t want to go to Switzerland to die. I just want to die at home with my family. And above all I don’t want to die in pain. I just want to die with dignity.

Canada as a secular, modern and sophisticated society is ready for more comprehensive legislation’s around dying and death. Rosie DiManno represents the dark religious medieval approach to this. Maybe we should drop the loaded suicide term. I feel “assisted dying” is better.

Arne Nes, Toronto

Thank you, Rosie DiManno, for a clear and inspiring article about the sacredness of life, even of a life that is nearing its end. I would like to give a copy to everyone who thinks that human beings who are no longer useful, or are costing us too much money or trouble or work, should be killed.

Claudine Goller, Scarborough

It is quite obvious that Rosie DiManno’s uncle Valentino was a courageous principled man. It also appears that he was a deeply religious person, in that he suffered excruciating pain over his final months. In this case, Valentino made the choice to suffer this unnecessary agony, probably because his religion stressed the fact that suicide was a mortal sin. He was of sound mind and was able to make that choice.

When Ms DiManno states that what she wanted to do was “kill the medical men and women around him who were failing so monstrously to alleviate his pain,” I feel that she didn’t use the word “kill” literally because, as she says, “I do not kill my animals, I’ve lain down with them, held them, waited for dogs and cats to draw their last breath.”

If the medical personnel had administered a pain killer such as morphine, depending on the medical condition of the patient, it may have hastened death, which to uncle Valentino’s family, could have been construed as an assisted suicide.

Legislation to allow people to “die with dignity” has to ensure that there are no loopholes that would allow doctors to participate in ending a life if a person was mentally incompetent, or in a comatose state, no matter the wishes of family members. The patient must be fully cognizant.

There are many diseases that inflict pain on the human body. Some, such as cancer and ALS, better known as Lou Gehrig’s disease, are more insidious than others. Pain becomes increasingly stronger as the disease progresses. Stephen Hawking is a perfect example of someone who chose to live with his pain and numerous disabilities. He has had ALS for 50 years (diagnosed in 1963) and has made enormous contributions to the scientific community while living with this disease. Others, who are less pain-tolerant, and without religious constraints, should be able to make the choice to end the eternal suffering being inflicted on their bodies.

This is not barbarous, it’s merciful.

Warren Dalton, Scarborough

I am afraid Ms DiManno is wearing her large crucifix out in public; but, then again, this is Ontario. Rosie promulgates Roman Catholic (and some fundamentalist Christian) views but she is writing from the long dark ages.

Thankfully, much of the Western World is slowly waking up to understand what dignity really is for a pain, agony-wreaked person in the final cruel stages of much unnecessary suffering.

My volunteer work in the palliative care unit of the Bickle Centre in Toronto has given me the opportunity to see the caring, loving work of the nurses amongst patients whose screams to be “let go” never fail to bring me to tears.

Dennis R. Punter, Toronto

The debate about assisted suicide and what it means to die with dignity has captured the attention of many in the health care field and beyond.

I am surprised and somewhat concerned that the role of hospice has not figured in the debate. When talking about dying with dignity, residential palliative care can and should be part of the equation.

The goal of hospice care is to provide the highest quality of life possible for whatever time remains. At Kensington Hospice we have a team of healthcare professionals and volunteers who provide therapeutic palliative care interventions when curative treatment is no longer an individual’s choice. In hospice patients are helped to gain more control over their lives, manage their pain and other symptoms effectively. At the same time much needed support is provided to the family which allows everyone to focus their energies on embracing the time they have left together in this final phase of life’s transition.

As difficult as the decision is to enter a hospice, families feel a sense of relief upon their arrival. Around the clock professional care allows each family member to return to his or her original relationship role and to fully explore the depth and breadth of their love and commitment to their loved one. For example, family members and loved ones needn’t bear the uncomfortable burden of meeting the continence needs of their loved one.

For individuals suffering from a life limiting illness, dying with dignity doesn’t have to be about choosing when to die. It can be about choosing to live in a home-like setting where there is support for the individual to best manage their pain so that they can get the most out of the life they have left.

Brian McFarlane, President and CEO, Kensington Health

It is evident to me that Ms DiManno wrote her column on a very emotional subject from an emotional rather than objective viewpoint. The issue of concern for “doctors with a God-complex” is quite separate from an individual with a terminal illness in unending pain wanting (even begging) for their life to end.

Sometimes medical science does not have the means to alleviate the pain without overdosing the pain killer. Should there not be a legal way for someone to make the decision for themselves? Instead, we take it upon ourselves to choose what is best for someone in such pain, and deny the suffering soul any say at all? I quote you, Ms DiManno — This is not mercy. It is barbarous.

Stephen Brouitt, Richmond Hill

I too watched my parents die, and while not as horrific, I did not want them to die. They didn’t want to either. They wanted to live. And when we as Jews wish someone that they should live until 120, we really mean forever. In good health is best, but with us here on earth, in any way, shape or form. And while many would argue, Rosie is right, life is sacred, and it is not up to us to decide when to kill someone. Let God do his job.

Denise Levin, Toronto

Rosie DiManno seems to like to play god with the issue of euthanasia to advance the argument that every terminally ill patient experiencing unbearable and irreversible pain must behave like her recently deceased uncle Valentino and suck up the pain without any choices.

Such a mindset lacks any sensitivity and compassion for the unbearable suffering incurred by people like Dr. Donald Low who was fully capable of opting for his right to die with dignity but was never granted his wish.

Robert Ariano, Scarborough

I enjoy reading Rosie DiManno’s columns and admire and respect her writings on various topics. However, her views on death with dignity fall short of her usual level-headedness.

Rosie writes that it is nature that the assisted suicide promoters wish to defy. That’s not correct because it is often the grievously ill or their obdurate relatives who actually defy nature by insisting on every available last-medical-hope to keep the patient alive.

Far from doing away with the terminally ill, the health care system, only at the express will and desire of such individuals and their care-givers, should provide an option to die with dignity and be done with their unbearably painful existence. If death is part of nature, then resorting to extreme yet useless heroic measures is not accepting with grace that which is inevitable.

Leaving aside the moral discussion, what about the ever escalating health care and drug costs that are looming so glaringly ahead of us? Our population is getting older and no sane person will deny that the two issues of aging and economics are closely inter-related. Humanely and judiciously administered, “death with dignity” therefore should have a place in our civil society.

Dina Austin, Bramalea

Rosie DiManno shows colossal arrogance. She believes that life is sacred and that any legal erosion of that view will create a slippery slope that would soon see Canada doing away with the elderly and the grievously ill.

Rosie’s views are different from mine, but they are not more right than mine, and I should not be forced by law to live my life according to Rosie’s beliefs.

If I make an informed, unpressured decision to end my life, which to me has become unbearable because of an irremediable medical condition, then I want the option to do so legally, with medical assistance to ensure it happens gently. I may never take that final step, but I need to know it is there for me in the future — it might just give me the courage to go on.

My advice to Rosie: If someone asks you to be their legal substitute decision-maker for care, make sure they know your view that unbearable agony is a dignified way of living, but that dying with dignity is barbaric.

Relax, Rosie, I’ll never ask you.

Françoise Hébert, PhD, board member, Dying with Dignity, Toronto

“Truth emerges from free discussion and free reporting. An informed public is essential to fostering and preserving Canada’s democratic society.”

It continues to perplex me how Rosie DiManno’s “opinion-based evidence making” serves this first principle of journalistic integrity as stated on the Star’s own website. DiManno’s cherry picking of tidbits of information affront that principle deeply. Rosie’s Uncle Val had a good death. Lucky man. Rosie’s Dad had a painful death. Poor man.

But to the names Uncle Val and Papa DiManno one must also add those of Gloria Taylor, Nagui Morcos, Donald Low, Sue Rodriguez, Tony Nicklinson, Ramón Sampedro, Amy Doolittle, Kay Carter and Susan Griffiths. Just a small sample of those seeking assistance with ending their lives, those who bravely few went public.

Baby Boomer Barbarians? I think not. Rather, I’d say, fairly ordinary people boldly facing the inevitable tragic choices of modern healthcare. The barbarism lays in the complete lack of empathy for those who speak form their own experience.

Rosie may choose to ignore this important bit of information that the public ought to have when pondering the complex reality of managed dying: many of us in healthcare and ethics practice actually do our best to see that people get what they want for themselves…be it every available life-sustaining treatment possible, or its withdrawal, often accompanied by a request for a deep sleep to usher them peacefully to their death.

For those in the perversely ‘lucky’ position to be able to refuse a life sustaining treatment, this is legal. For those who ain’t so ‘lucky’… it is not. It’s ‘yucky’. Neither the best palliative care nor even the most opinionated outrage and ignorant hyperbole will help all those who are facing it.

Thankfully, some are there, facing the yuck day after day .... helping .... and advocating for a broader more informed perspective on dignity and grace at the end of life.

Let it be clear that dying with dignity refers to an end-of-life choice made solely by the patient. Any set of laws regarding free choice at our time of death must ensure that only the patient has made the decision on how and when to die.

It has long been a primary function of the medical profession to relieve pain and suffering. The amount of pain that one can endure is only known by the patient and its relief must also be decided by that individual.

Dying with dignity requires that all of us show respect and empathy to each of us at the end of our lives.

Roger Hilderley, Stratford

Rosie DiManno’s piece showed breathtaking audacity in not once mentioning Dr. Donald Low’s video. His video is the reason this subject is topical right now, but I do understand her reasoning for omitting it. Comparing his words with hers would define the distinction between the walk and the talk for once and for all.

Andrew MacGregor, Etobicoke

I’m a long time and avid fan of Rosie DiManno, but on this issue have to take exception. Rosie refers to doctors deciding when to withdraw life-sustaining treatment and I believe she’s right up to the point where she claims that “all life is sacred” and “sacred” implies to me religion. At that point I disagree.

I don’t know Rosie’s attitude toward abortion but, if I’m right, though she might never want one herself, she would feel that it is her right to choose. It’s her body. Well this is my body and whatever I believe about religion I don’t want someone else’s beliefs imposed on me, especially with something as important as my life.

Can anyone really believe that, though doctors and other should not have the right to decide for me when to end my life, they should have the right to tell me that, even though my life has no dignity or I’m screaming with pain for which there is no help, only their God, in which I may not believe, should decide for me when it will end.

And, who decided that God did not also give us that choice too (though we may take the lives of others when our leaders and holy men say it’s right) - words in a book written by men?

Jim Latimer, Wasaga Beach

Like thousands of other Canadians, I expect to die within the next 10 years or so. I hope that by then I will be able to dictate the nature of my death. But at the very least, I want life to end without agony, free from imprisonment on a biological death row inside a wretched body.

I don’t want my kids to carry the burden of deciding when and how I should died. Nor would I willingly vest that authority in a detached physician, let alone those who share the views of Rosie DiManno, who seem to accept terminal illness as a natural passage, part of life so to speak: Let it follow its course, we’ll tweak it with painkillers.

I have witnessed lots of painful and tragic deaths in my lifetime, and I don’t want to go that way. And I don’t want to be told that I should by individuals, associations or institutions with moral standards not my own. Why should they decide how I should depart this vale of tears?

When I first read of Dr. Donald Low’s views in his death notice and later saw him articulate his video call to assist those who wish to hasten their inevitable demise, I gave forth a soft cheer of support, knowing that in death he had opened the issue to long-overdue discussion and debate in Canada. So allow me to offer my thoughts.

I don’t accept the description of medical intervention to hasten death as murder or “assisted suicide.” I see it as a merciful release from an emotional and sometimes physical agony that can drag on for weeks or months before reaching its inevitable conclusion. I believe a person faced with such circumstances should be able to choose the nature of his or her death, either in advance in a living will or verbally at the time of diagnosis.

Hopefully, the discussion and society will have progressed in the future to the point where I can make that call and have it followed when my time comes.

George Hutchison, Toronto

My favorite columnist, Rosie DiManno misses the point in her column. She sites examples from her own family and notes that they have died in pain without ever suggesting that their lives be terminated.

While their attitude and determination are admirable, this was not their choice. Current laws did not give Rosie’s relatives a choice. Many, Rosie’s relatives included, may want to bravely carry on no matter what the toll this takes on themselves, their relatives and the medical system.

If this were a choice they would have a right to it. But others may want to choose to die quietly and peacefully when the time comes. This should be their choice.

The underlying tone of Rosie’s column is that the choice might fall to someone other than the individual involved. And this is a real danger but it can be overcome. The catch here of course is preparation. People should make this choice while still healthy and in complete control of their faculties.

After careful consideration, a clear statement of their intent should be drafted and kept with a secure source so as to avoid any ambiguity at critical times.

Tom Sullivan, Toronto

Rosie DiDanno’s rant takes up a third of a page but amazingly offers nothing substantial to support her position against assisted death. The slippery slope “argument” is not an argument at all but merely a red herring that does not address nor relate to the matter of whether a competent person might want to choose to check out just in time.

And Rosie’s opinion that all life is “sacred” is not a real argument either but simply an opinion apparently based, according to my dictionary, on belief in some deity. This is a serious topic and deserves thoughtful discussion. The positions on all sides must be evaluated honestly. Ranting will not do.

Jim Cunningham, Oakville

My compliments to Rosie DiManno, who gets it right maybe 90 per cent of the time. But in her Monday column, she misses the point. She strongly opposes assisted death. In some circumstances, I strongly favour it. If it were legalized, no one is telling her that she must believe in it or be a party to it.

But she must not tell me and others how we must think and act. At 76 years of age, I am much closer to the reality of death than is she.

John Goodings, Toronto

I couldn’t disagree with Ms. DiManno more on this subject. I watched both my parents die. My mother chose to stay at home and live every day that she could. We, as a family helped her to do this as it was her wish. My father, on the other hand, had been done with living long before he died. He would beg me to help him end his suffering but I was helpless and that made me very angry that I couldn’t fulfill his wish as we had done for my mother.

Regarding Ms. DiManno’s point that previous generations had endured end of life suffering so why can’t we follow suit. People that lived in previous generations died long before people do now due to Doctor interventions. This is why when certain people say that people will die when God decides I say “ No they won’t “! We will keep people living much longer than they were meant to.

My only concession is that only the person wishing to end their life should be able to make that decision. Even though I didn’t feel my mother had a very good quality of life I never once felt I had the right to end her life.

Let all people choose which way they want to end this life. An open discussion is what we need not sanctimoniously declaring it as “Barbaric”!

Kathy Fowler, Port Severn

What an intelligent analysis of dying with dignity. Our society has become so taken with youth and beauty that the idea of anyone who cannot be fixed to fit that pattern is inconceivable. Legislation is not needed to decide who has the right to die. Surely humans have the ability to reach out and care — it’s called compassion.

Faye Huber, Toronto

Rosie, thank you for the cuff on the head.

I have watched my father deteriorate over the last seven years from Alzheimer’s disease. It’s been devastating to watch a vital person, especially since that person is my dad, disintegrate before my eyes. It’s been equally devastating to witness my mother’s suffering. When I’m at the abyss of despair i would pray for my dad’s death. Why? I told myself that “he wouldn’t want to live this way”, I wanted my mother to try and enjoy the years remaining to her, I didn’t want to see my dad cry, I didn’t want to see him wearing a diaper.

Then today, i read your column. I felt embarrassed to have been in the “right to die” camp. You’re right. His state of “grace” is a gift to us. I am reminded of a passage in the book, Tuesdays with Morrie, when Morrie, dying of ALS was asked if he felt embarrassed by not being able to tend to his own needs. His response was something to the effect of, no, I feel loved and fortunate to have people in my life who care for me as one would care for a newborn baby...Interesting, that we just accept all the “indignities” associated with babies (pooping, peeing their pants, drooling, temper tantrums, etc) but not with those older individuals who are unable to care for themselves.

I am grateful for seemingly small blessings...when occasionally my dad’s ol’ blue eyes will temporarily get that sparkle back and we can sing or laugh together. When i see the softer, more vulnerable side of him. When he tells me he loves me (not something that came easily to him prior to getting sick) When he’s so loving with my mom. (also, not something that came easily to him prior) Had he died earlier on we probably would not have experienced these moments.

Yes, we are developing into a society that when things get “icky” we try and make it less so instead of going with it. After all, this tidies things up for all involved doesn’t it? We want everything “now”, to hell with transition. However, death is indeed part of life and helping someone on that part of their journey can be one of the most intimate and gratifying things one can do. It is possibly one of life’s greatest and hardest lessons. Despite the hardships we all endure, the one thing i will try and remember is that this is my dad’s life, not mine. I hope that he is at peace, forgetting the bad, not hoping for the future, just being in the moment. For all the good and all the bad, he is and always will be my dad.

Thank you for the wake up call.

Joanne Spironello, Vineland

I took my training in clinical pastoral education at Toronto General and prayed with families. I sat with my parents as they died. I am appalled at the cheapness of life that comes from those who talk about death with dignity. Life is dignified — not death.

It is an upstream battle against assisted-suicide. Most people requesting assistance with their deaths are quite capable of taking their own lives. No need to fly to Switzerland. Just collect your pain pills and take them, here, by yourself. I have been suicidal and I have been with those who are suicidal. We don’t need help. We know what to do.

It’s as if these people are asking permission from their family members to die. And what will the family say? No! They are guilted into accepting the request.

When I wanted my life to end, I didn’t seek permission. In my mental state I knew I was doing the right thing.

Diane Weber Bederman, Toronto

Rosie DiManno’s moral argument doesn’t hold up. She suggests death is a part of life and should be experienced through palliative care. Somehow she feels experiencing death through a drug-induced stupor while eventually falling into a coma and drowning in your own fluids is morally superior. This is fine, if that’s what you want.

However, the real argument is about being allowed a personal choice. Where a patient is clearly terminal there should be no moral dilemma in allowing them a relatively quick and painless exit option.

Dave Jenkins, Kincardine

Any real discussion of this concept of allowing people to make their own choice to continue in pain from disease or end their life is automatically shut down because of articles like that of Rosie DiManno.People out of fear jump to the image of “a slippery slope towards the annihilation of human beings.”

The aim of offering such a choice is to allow “each person” to make one of the most important choices of their lives and end their lives in a more humane way.

With thoughtful and careful guidelines for such a choice there can be no annihilation of human beings to save the health care costs.

Each person who has had the ability to choose their career, to choose their marriage partner, and to choose to have children at present cannot choose to end their lives even if they experience intolerable pain. Suddenly we put a barrier up and claim they are “not capable” of making such a decision.

Let’s have a full discussion of the topic of “assisted suicide” and develop ways of allowing those in severe pain to receive the mercy we presently bestow on our pets.

Bonnie Bacvar, North York

Says Rosie DiManno, “ It is repugnant that we are now discussing doing away with the elderly, the diseased, the terminally ill.” But no one is suggesting “doing away” with anyone who doesn’t want to be done away with.

If Ms DiManno wants to live out every single second of her “existential existence” in unbearable pain or incessant psychological anguish, that is her right and no one is going to stop her. Assisted suicide is about helping those who persistently and unambiguously ask for death. “Helping” people to die who don’t wish it is called murder for which the law provides a remedy.

Ms DiManno notes that we do not choose the moment we are born and nor should we be able to choose the end either. The former is clearly out of our hands but the latter is not. Whether we embrace death on our terms or let nature play out the string is up to us. It always has been.

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